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Successful ageing

Dr. Kiyoshi Kurokawa, a member of the WHO Commission on Social Determinants of Health, gives an overview of the recent progress made in relation to population ageing. As we are now living longer, medical research is also focusing on lowering elderly disability. At Olympus, advances in synthetic bone replacement therapies promise the elderly a better quality of life, through extended mobility.

Science and the increase in life expectancy

Over the past 150 years more has been done to improve human health than any other period we know of. There have been impressive technological improvements and breakthroughs in the medical sciences (e.g. new vaccines, eradication of smallpox) and human knowledge, such as how to build better city sanitation systems.

The changes are summarized in the table below:

Year

Life Expectency

Key Events

1840

45

1842 Edwin Chadwick publishes his Report on the Sanitary Condition of the Labouring Population of Great Britain, affirming the importance of environmental conditions to health

1851

50

1854 John Snow closes London’s Broad Street water pump to prevent spread of cholera
1862 Louis Pasteur establishes his germ theory: infection is caused by living organisms, not by “spontaneous generation”

1953 Francis Crick and James Watson publish their paper proposing the double helix structure of DNA
1972 Archie Cochrane publishes “Effectiveness and Efficiency: Random Reflections on Health Services”, on the importance of using evidence to provide equitable health care

1979 Worldwide eradication of smallpox

1980

80

1999 World population reaches 6 billion

Multiple roles for science in relation to ageing

Disability is declining among older people in some countries. A study in the United States in 1999 found that improvements in medical technology is one factor in reducing disability, with examples including joint replacement and cataract surgery. Meanwhile, advances in the use of anti-inflammatory and disease-modifying antirheumatic drugs are given as one explanation for the reduction in disabilities due to arthritis. Finally, the several other classes of pharmaceuticals have been associated with a decline in the incidence of strokes.

Improving the level of functioning of the oldest people and preventing disability is undoubtedly difficult, but strong public health policies are providing more research and resources to help healthcare professionals to meet this challenge. The example of Olympus highlights the potential of new medical innovations in tackling key problems affecting the health and welfare of the elderly.

Science can also play key role in providing enhanced understanding of the key factors influencing longevity. The example of Dr. Hirose from Keio University illustrates how scientific research is helping to unravel the mysteries of ageing and the reasons behind increased longevity. He is examining Japanese centenarians and studying a wide range of factors that could influence their longevity. This include biological, environmental and individual characteristics. The research is still in its early stages but the ultimate goal is to better understand the ageing process.

There is, however, no clear consensus and indeed considerable controversy within the academic and research community on the role that science can play in enhancing quality of life or even prolonging life for the elderly (Stefánsson 2005). Juengst et al (2003) give three examples of where the research agenda is focused:

Compressed morbidity: The goal here is to forestall all chronic ailments of old age by intervening in the underlying molecular processes. The aim is to increase average human life expectancy, but not necessarily to increase maximum human lifespan. Essentially, as a result, we would stay healthy, longer.

Decelerated ageing approach: The objective is to slow down the fundamental processes of ageing to the extent that average life expectancy and maximum lifespan are increased.

Arrested ageing: Put simply, this approach seeks to ‘cure’ ageing. The goal of arrested ageing is to continually restore vitality and bodily function by removing the damage that is inevitably caused by metabolic processes.

The first two are relatively uncontroversial and receive considerable public sector funding in the USA, Japan and Europe. The notion of arrested ageing, however, is less well accepted. The negative implications of this approach are discussed in Stephansson 2005.
The role of research

Developments in the area of biotechnologies, pharmacology and genetics undoubtedly offer great opportunities and challenges. While research on ageing has traditionally been concerned with life expectancy and mortality, the concept of functional capacity has been attracting growing attention.

Advances in technologies are already making a contribution in reducing distress for patients and their carers, but upscaling international efforts is needed.

Major investment area for Kobe

Regenerative medicine is viewed by many governments around the world as an important area for future investment and economic growth. It is also an important feature of the Kobe Medical Industry Development Project.

This project is designed to nurture industrial development in the fields of advanced medical care that meet the requirements of Japan’s rapidly aging society and improve the quality of medical services.

Key to the Kobe Medical Industry Development project is cell therapy and regenerative medicine research. This initiative is expected to make an important global contribution to the improvement of knowledge and technology in this area.